Hi Phyllis !

Sounds like nipple/breast yeast to me.  See what you find when you see this
mother tomorrow.  If the damage is at the nipple tip, there is probably some
difficulty with attachment that may relate to infant position, mother's anatomy,
mother's hands in the way, etc.  However, from your description, I am assuming
that the damage is at the base of the nipple where it joins areola.  This type
of razor-like cut is typical of yeast.  So is the description of the pain as
"stinging"------as is the mention of pain going through the breast.

I have seldom had luck with mothers using lotrimin.  You may want to try
nystatin cream for monther and suspension for infant.  Or if aggressive therapy
is desired (or if nystatin does not work, a fact that is becoming more common),
a 1/2% aqueous based solution of gentian violet may be tried on nips (2X day, 3
days) and in infant mouth (1X day, carefully, 2 - 3 days).  Or use the diflucan.


My practice has been to present alternatives to the mother and let her choose.
Then I call the physicians with suggested problem & remedy asking what they want
to do. If the yeast is to the point of the nipple crack and deep breast pain,
the diflucan may be first choice.  Since the physician will not be used to using
it for this purpose, have dosage suggestions ready.  I generally present more
than one dosage suggestion.  Oral nystatin may also be a choice for this severe
yeast  overgrowth.

Let me know if our yeast care plan for patients will be helpful to you and I
will mail it.  It outlines the procedure for using topical meds on nipples and
infant mouth, hand washing, clothes and equipment cleaning,etc.  I also make
verbal suggestions regarding diet--add yogurt, acidophilus, decrease red meats
and sugars.

Yeast is more and more a problem and more and more difficult to treat.  We have
had some cases that did not respond to any traditional remedy.  We refer these
mothers to someone in the community who is knowledgeble regarding homeopathy.
She has worked successfully with our yeasty mothers.


Good Luck!!

On a more personal note:
Are you going to the Mid-South meeting on the 20th?  I haven't decided yet----am
becoming more and more resistent to things that make my work week longer that it
already is.  I was glad to hear that we will have your input on the
breastfeeding duration study that Queens College is doing for us.  I am excited
about it-----but not about the 300+ telephone numbers that I have to pull up on
the computer!

Pardee